The association of empirical #treatment with #oseltamivir with the #outcome of critically ill patients admitted with severe acute respiratory illness (#SARI)

 

Abstract

Objective

Neuraminidase inhibitors (NAIs) are widely used empirically in critically ill patients with suspected influenza; however, their effect on mortality remains uncertain. This multicenter study evaluates the association between empirical treatment with oseltamivir and the outcome of critically ill patients with Severe Acute Respiratory Infection (SARI) admitted to the Intensive Care Unit (ICU).

Methods

This was a retrospective cohort study conducted in the ICUs of four hospitals in Saudi Arabia, involving adult patients with SARI from September 2012 to December 2018. Data collected were: demographics, comorbidities, clinical presentation, and outcomes among patients treated with oseltamivir and those who were not. The primary outcome was 90-day mortality. The association of oseltamivir and mortality was evaluated adjusting for propensity score.

Results

During the study period, 456 patients with SARI were included in the study, 301 were treated with empirical oseltamivir within a median of 1 day from presentation (interquartile range, 0-1 day) and a median of 4 days after symptom onset, while 155 patients were not. No significant differences were observed in baseline characteristics between the two groups. Of the included patients, 334 (73%) were tested for influenza using PCR, and 87 (26%) had a confirmed diagnosis of influenza. Patients on oseltamivir were less likely to require rescue oxygen therapy (22.9% vs. 34.8%, p=0.007), and had shorter hospital stay (20 days vs. 27 days, p=0.01). Patients treated with oseltamivir had significantly reduced 90-day mortality on adjusted analyses (aOR: 0.87, 95% CI: 0.81-0.94, p=0.0002). Subgroup analysis revealed that the association with reduced mortality extends to patients >70 years old (aOR: 0.94, 95% CI: 0.89-0.99, p=0.02) and those with negative influenza tests (aOR: 0.81, 95% CI: 0.79, 0.84, p<0.0001).

Conclusion

Among critically ill patients with SARI, empirical treatment with oseltamivir was associated with lower mortality. These results add to the body of evidence suggesting clinical benefits of oseltamivir in managing critically ill patients with influenza-like illnesses.

Source: 

Link: https://journals.sagepub.com/doi/10.1177/20503121261478401

____

Easily Scalable, Rapidly Deployable Mechanical Ventilator for Pandemic Health Crises in Resource-Limited Areas

 

Abstract

Background: 

The COVID-19 pandemic exposed critical shortages of mechanical ventilators, particularly in low-resource settings. Disruptions in global supply chains and dependence on specialized components highlighted the need for scalable, locally manufacturing alternatives for emergency respiratory support. 

Aim: 

To describe and evaluate a simplified, supply-chain-independent mechanical ventilator assembled from widely available automotive and simple hardware components, and intended as a last-resort solution. 

Methods: 

The ventilator is based on a reciprocating air pump driven by an automotive windshield wiper motor coupled to parallel shaft bellows and readily assembled passive membrane valves, only requiring materials available from standard hardware retailers, minimal tools, and basic manual skills. Ventilator performance was assessed through bench testing using a patient model simulating severe lung disease in an adult (R=20 cmH2O*s/L, C=15 mL/cmH2O) and pediatric (R=50 cmH2O*s/L, C=10 mL/cmH2O) patients. Realistic proof of concept was performed in four mechanically ventilated 50-kg pigs. 

Results: 

The device delivered tidal volumes up to 600 mL and respiratory rates up to 45 breaths/min with PEEP up to 10 cmH₂O, covering pediatric and adult ventilation ranges. In vivo testing showed that the ventilator maintained arterial blood gases within the targeted range. Technical details for ventilator construction are provided in an open-source video tutorial. 

Discussion: 

This low-cost ventilator demonstrated adequate performance under demanding conditions. Although not a substitute for commercial intensive care ventilators, its simplicity, autonomy, and independence from fragile supply chains provide a potentially life-saving option in resource-constrained emergency scenarios.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This work was partially supported by Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR) (grant 1381-2022). SEPAR had no involvement other than providing funding for the independently submitted research project.

Source: 

Link: https://www.medrxiv.org/content/10.64898/2026.04.08.26350386v1

____